Empiric treatment with a fluoroquinolone delays the treatment for tuberculosis and is associated with poor prognosis in endemic area

Jann-Yuan Wang ¹, Po-Ren Hsueh ¹, I-Shiow Jan ¹, Li-Na Lee ^1*, Yuang-Shuang Liaw ¹, Pan-Chyr Yang ¹ and Kwen-Tay Luh ¹

¹ National Taiwan University Hospital, Taiwan

^* To whom correspondence should be addressed. E-mail: linalee{at}ccms.ntu.edu.tw.

Accepted 9 June 2006

Abstract

Background: This study was conducted to evaluate the impact of empiric fluoroquinolone use on the timing of anti-tuberculous treatment and outcome of tuberculosis patients in an endemic area.

Methods: All culture-confirmed tuberculosis patients aged 14 years from July 2002 through December 2003 were included and their medical records were reviewed.

Results: Of the 548 tuberculosis patients, 79 (14.4%) received a fluoroquinolone (FQ group), 218 a non-fluoroquinolone (AB group) and 251 no antibiotics before anti-tuberculous treatment. Fifty-two (65.8%) experienced clinical improvement after fluoroquinolone use. In the FQ group, the median interval from initial visit to anti-tuberculous treatment was longer (41 vs. 16 vs. 7 days), and the prognosis was worse (hazard ratio 6.88 [1.84 - 25.72]). More patients in the FQ and AB groups were older than 65 years (53.2% and 61.0% vs. 31.5%), and had underlying disease (53.2% and 46.8% vs. 34.3%) and were hypoalbuminemic (67.2% and 64.9% vs. 35.1%). Of the 9 mycobacterial isolates obtained after fluoroquinolone use from 9 patients whose initial isolates were ofloxacin-susceptible, 1 (11.1%, after 7-day fluoroquinolone use) was ofloxacin-resistant. Independent poor prognostic factors included empiric fluoroquinolone use, age > 65, underlying disease, hypoalbuminemia, and lack of early anti-tuberculous treatment.

Conclusions: Of our tuberculosis patients, 14.4% received a fluoroquinolone before the diagnosis. With 34-day delay in anti-tuberculous treatment and more frequent coexistence of underlying disease and hypoalbuminemia, empiric fluoroquinolone therapy was associated with a poor outcome. M. tuberculosis isolates could obtain ofloxacin-resistance within 1 week.

Keywords: albumin, delay in treatment, fluoroquinolone, tuberculosis, underlying disease

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